Intended for healthcare professionals

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Education And Debate

Learner centred approaches in medical education

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7193.1280 (Published 08 May 1999) Cite this as: BMJ 1999;318:1280

Rapid Response:

Learner centred approaches in medical education: its relevance in developing countries

Editor-

The article by Spencer and Jordan cover several areas of interest in
medical education 1. However, there are two areas of concern to medical
educators in the developing countries. Firstly, we often see "teacher
dominated approach" (extending from primary and secondary schools and
based on a culture of obedience to elders), which is an extreme form of
teacher centred approach, often characterized by showing little respect to
the basic human dignity of the learner. For example, the learners are
questioned in an intimidating manner, humiliated in front of peers by
laughing at "wrong answers" and shouted at (again in front of peers), for
not completing allocated tasks. This form of domination during teaching
activities (with the teacher controlling the ultimate weapon in the form
of conducting a subjective assessment such as a viva voce), breeds
obedience and dependency on the teacher for information that is
"politically right". Thereby,
creativity of the learner is thwarted and independent self-directed
learning is inhibited. Thus an initial step to foster self-directed
learning in developing countries should be to wean off this unhealthy
domination of learners by teachers. Staff development should highlight the
detrimental
effects of these aspects in addition to educational methodology etc.

Secondly, there is a slow diffusion of innovations, often because the
teachers are ignorant or feel threatened with newer concepts in adult
learning, (especially if these methods encourage more control to the
learner!). Other explanations for slow diffusion include the strict
hierarchical organizational structures in the medical schools, which
inhibit innovations and responsiveness of organizations to newer
developments. Cultural factors, such as avoidance of uncertainty described
in Asian and
African countries, too are likely to play roles in inhibiting innovative
developments 2. Thus, for if the role of teachers is to change, we need to
consider organizational restructuring (from a rigid vertical structure to
a more networked horizontal structure responsive to innovations) and
evolution of culture (at least within the university system). These would
form the macro contextual factors, which should supplement staff
development at all levels.

Saroj Jayasinghe

Associate Professor

Department of Clinical Medicine,
Faculty of Medicine,
Kynsey Road,
Colombo 8,
Sri Lanka

References

1 Spencer JA, Jordan RK. Learner centred approaches in medical education.
BMJ 1999, 318, 1280-3.

2 Hofstede G. Cultures and Organizations, Software of the mind,
London, HarperCollins Publishers, 1994.

Competing interests: No competing interests

09 June 1999
Saroj Jayasinghe